• Stefan Mausbach, Teresa van Spankeren, Helge Hudel, Ingo Schirotzik, Maxime Viard, Tobias Struffert, and Manfred Kaps.
• Department of Neurology and Neurocritical Care Medicine, Shaare Zedek Medical Center, Jerusalem, Israel. Mausbach@posteo.de.
• Neurocrit Care. 2024 Apr 1; 40 (2): 562567562-567.

BackgroundDespite breakthroughs in stroke treatment, some patients still experience large infarctions of the cerebral hemispheres resulting in mass effect and tissue displacement. The evolution of mass effect is currently monitored using serial computed tomography (CT) imaging. However, there are patients who are ineligible for transport, and there are limited options for bedside monitoring of unilateral tissue shift.MethodsWe used fusion imaging for overlaying transcranial color duplex with CT angiography. This method allows overlay of live ultrasound on top of CT or magnetic resonance imaging scans. Patients with large hemispheric infarctions were eligible to participate. Position data from the source files were used and matched with live imaging and correlation to magnetic probes on the patient's forehead and ultrasound probe. Shift of cerebral parenchyma, displacement of the anterior cerebral arteries, basilary artery and third ventricle were analyzed, as well as pressure on the midbrain, and the displacement of the basilar artery on the head were analyzed. Patients received multiple examinations in addition to standard care of treatment with CT imaging.ResultsThe sensitivity for diagnosing a shift of 3 mm with fusion imaging was 100%, with a specificity of 95%. No side effects or interactions with critical care equipment were recorded.ConclusionsFusion imaging is an easy method to access and acquire measurements for critical care patients and follow-up of tissue and vascular displacement after stroke. Fusion imaging may be a decisive support for indicating hemicraniectomy.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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